Part 1 of VOA's 5-part series on Health Care

The American health care system has been called one of the best and worst in the world.  Many experts say it is certainly the most expensive, costing $2.5 trillion a year or about $7,000 to $8,000 per person.  Most Americans pay for their medical care through private insurance, which is partially subsidized by their employers.  Elderly Americans receive health care largely paid for by a government trust fund that may eventually run out of money.  An estimated 30 million others - a majority of them considered the working poor - have no health insurance at all.  Here's our report on some of the causes for a health care system in crisis.

Wanting it all

As a nation, America seems to want it all.  Patients want the best medical treatment. But some,  like Jarene Williams whose young son was sick with a congenital defect, are shocked when the bill comes in.  

"We started getting these surprise bills," she said. "I said 'wait a minute.  We're insured.'"

Family physician David Ellington says doctors want to provide the latest medical treatment, but reimbursements they receive from health insurance companies are not enough to cover their expenses or keep them in practice.

"There is going to have to be some type of arrangement in the way doctors are paid," he said.

Too Costly

Small business owners say they want to provide medical coverage for their employees, but are finding it hard to sustain their share of the cost.

Amy Milstead Ellzey is president of family-owned Milstead Automotive Ltd. She says struggles to provide an affordable plan for her employees.  

"It is terrible," she said. "We cannot afford a 44 percent increase in medical insurance, so that, in turn, makes us have to start looking elsewhere for different plans and it makes us have to cut the plan back some."

Nationwide polls have shown that most Americans want improvements made in their health care system.  President Barack Obama signaled to Congress recently that decades of rising costs for a medical system which does not treat everyone fairly must end.

"The cost of our health-care has weighed down our economy and the conscience of our nation long enough," said Mr. Obama. "So let there be no doubt:  health care reform cannot wait, it must not wait, and it will not wait another year." 

Everyone should be included

Jonathan Weiner is a professor of health policy at the Johns Hopkins School of Public Health in Baltimore, Maryland.  

He says the biggest challenge in health reform is making sure that everyone is included: that no American be shut out from some kind of medical coverage,  whether it be private insurance or government funded, because of a pre-existing medical condition or low income.

"For the many 40-50 millions of Americans who don't have health insurance, of course, that's the number one issue, getting them covered," noted Weiner. " Without a health insurance card, it's not as if we don't care for people without insurance cards, the care is sporadic and often incomplete.  And they get half the health care coverage that everyone else gets."

New program for working poor

Weiner believes the eventual legislation will include the working poor who earn too much to qualify for the government assistance program called Medicaid.  He says they will be enrolled in some kind of other public option program or private insurance plan.

"That's going to be one of the most positive changes in health care that I think every American should be pleased to see, that health insurers must take you without regard to your disease," he said. "

Weiner also says for too long the American health care system has paid medical fees based on the severity of the patient's illness and far less for prevention of chronic diseases.

"Right now doctors get paid more and more for ordering tests," he said. "The sicker their patients become, the more they get paid. We need to shift to a system that - that - rewards efficiency, that rewards making people healthy."

Costly proposal

President Obama says his health care proposals would cost about $900 billion over the next decade, funded in part by money already allocated in the existing health care system.  

Critics say the existing system is wasteful, inefficient, full of unnecessary administrative costs, and steered by poor management.  

Patients and their insurers, they say, pay inflated prices for medical care that is sometimes not appropriate,  as well as for the care of others who are uninsured.

In a joint address to the U.S. Congress on September 9, President Obama said it has been almost a century since another president, Theodore Roosevelt, first called for health care reform.  

"I understand how difficult this health care debate has been," the president said. "I know that many in this country are deeply skeptical that government is looking out for them. "